Functioning of the Human Heart in the Pron-Position.

Aim      To study intracardiac hemodynamics in healthy men in supine and prone positions.Material and methods  This echocardiography study included 14 apparently healthy men at a mean age of 38 years.Results In a prone position, the heart configuration and location in the chest changed, the heart rate increased by 7.3 %, and the transaortic flow velocity decreased by 13.7 %. Also, early and late right ventricular diastolic filling velocities and the pulmonary artery flow velocity were increased by 31.7, 11.4, and 5.6 %, respectively. In the intact tricuspid valve, the velocity and regurgitation pressure gradient were reduced by 7 % and 14.2 %, respectively.Conclusion      In a prone position, spatial changes in the location of the heart and its structures influence velocities of intracardiac blood flow, which may initiate the development of heart failure if the prone position is long-lasting.

Effect of Sex on Structural and Morphological Parameters of Rat Heart under Conditions of Combined Exposure to Hypokinesia and Cold.

We studied the combined effect of hypokinesia and external cooling on structural and morphological changes in the ventricular myocardium and parameters of homeostasis of the blood system in male and female WKY (normotensive) and SHR (hypertensive) rats. Simultaneous exposure to hypokinesia and cold caused destructive processes in the myocardium and high dynamics of heart remodeling with diverse structural and morphological changes in the left ventricle in rats of both sexes. The thickness of the left ventricular wall most rapidly decreased in male hypertensive SHR rats. The thickness of the wall of the right ventricle significantly increased in male and female rats of both strains. In WKY and SHR females, structural transformations in the heart were less pronounced than in males. The key role in different degree of morphological remodeling of the myocardium in male and female probably belongs to sex hormones.

Changes in Total Cholesterol and Heart Rate in Normotensive and Hypertensive Rats under Combined Influence of Cold Exposure and Hypokinesia.

We studied the effect of hypokinesia alone and in combination with cold exposure on HR and total cholesterol content in the blood serum of Wistar, WKY, and SHR rats. Irrespectively of the season, hypokinesia was associated with a decrease in HR, which is probably a result of reduced body needs due to deceleration of metabolic processes. A significant increase in total cholesterol was found under conditions of cold exposure combined with hypokinesia, which indicates qualitative structural rearrangement of energy metabolism under the influence of environmental factors. In winter, the increase in total cholesterol concentration was more pronounced (by 51.5%) in the group of hypertensive animals. Presumably, the increase in the serum concentration of total cholesterol under conditions of hypokinesia and cold exposure is a predictor of structural changes in the heart.

Combined Effects of Hypokinesia and Ambient Temperature on Heart Remodeling in Normotensive and Hypertensive Rats.

We studied the effect of hypokinesia combined with cold exposure on morphological parameters of the heart in Wistar-Kyoto rats and rats with spontaneous genetically determined hypertension (SHR). The pathological processes developing in the heart of white laboratory rats significantly affected cardiac function and manifested in the deterioration of the morphological structure of the heart: reduction of heart weight, thinning of the free wall of the left ventricle. These changes indicate transition to a lower energy level of functioning. At the same time, hypertrophy of the right free wall develops in both rat lines. Combined effect of hypokinesia and cold is probably a factor indirectly promoting the development of pulmonary heart.

Irregular Ventricular Tachycardia as a Mechanism of Stabilization of Mechanoelectrical Processes in Canine Heart under Conditions of Antiorthostatic Hypokinesia.

We studied electrophysiological mechanisms of ventricular arrhythmias in dogs (n=7) under conditions of antiorthostatic hypokinesia (head-down tilt 45°). Abnormal transmural heterogeneity of repolarization in the base and apex of the left ventricle and increased dispersion of myocardial repolarization were revealed. By minute 30 of antiorthostatic hypokinesia, an increase in the duration of repolarization was revealed after a period of ventricular arrhythmia in all segments and regions of heart ventricles, which was accompanied by impairment of the pumping function of the heart. A hypothesis on the physiological role of ventricular tachycardia as a mechanism of electromechanical homeostatic stabilization in the heart was proposed. The obtained results suggest that under conditions of antiorthostatic hypokinesia, canine heart after a paroxysm of irregular ventricular tachycardia becomes more resistant to arrhythmia.

Isoprenaline Impairs Contractile Function of Ventricular Myocardium in Common Frog (Rana temporaria).

The contractile function of the heart was studied in adult frogs Rana temporaria under the influence of a toxic dose of isoprenaline under conditions of natural sinoatrial rhythm and during heart pacing. The dynamics of ventricular pressure was recorded with a Prucka MacLab 2000 instrument via a catheter introduced into the ventricle through the ventricular wall. Reduced (p<0.05) parameters of the pump function (HR, maximum ventricular systolic pressure, isovolumic indices dP/dtmax and dP/dtmin) and lengthening of QRS complex and QT interval on ECG attested to impairment of contractile function and electrical processes after exposure to isoprenaline. Electrical stimulation of the right atrium improved myocardial contractility and ECG parameters after the administration of isoprenaline.

Mechanism of electrocardiographic T-wave flattening in diabetes mellitus: experimental and simulation study.

In the present study we investigated the contribution of ventricular repolarization time (RT) dispersion (the maximal difference in RT) and RT gradients (the differences in RT in apicobasal, anteroposterior and interventricular directions) to T-wave flattening in a setting of experimental diabetes mellitus. In 9 healthy and 11 diabetic (alloxan model) open-chest rabbits, we measured RT in ventricular epicardial electrograms. To specify the contributions of apicobasal, interventricular and anteroposterior RT gradients and RT dispersion to the body surface potentials we determined T-wave voltage differences between modified upper- and lower-chest precordial leads (T-wave amplitude dispersions, TWAD). Expression of RT gradients and RT dispersion in the correspondent TWAD parameters was studied by computer simulations. Diabetic rabbits demonstrated flattened T-waves in precordial leads associated with increased anteroposterior and decreased apicobasal RT gradients (P<0.05) due to RT prolongation at the apex. For diabetics, simulations predicted the preserved T-vector length and altered sagittal and longitudinal TWAD proven by experimental measurements. T-wave flattening in the diabetic rabbits was not due to changes in RT dispersion, but reflected the redistributed ventricular repolarization pattern with prolonged apical repolarization resulting in increased anteroposterior and decreased apicobasal RT gradients.

[Effect of the heart electric stimulation on repolarization of fish and amphibian ventricular myocardium].

By the method of synchronous multielectrode cartography (24-unipolar leads), distribution of durations and time of end of repolarization were studied on ventricular epicardium of pikes (Esox lucius) and frogs (Rana esculenta) and in ventricular intramural layers of toads (Bufo bufo) at the ectopic heart excitation. The time of arrival of the excitation wave and of the end of repolarization in each lead was determined from the minimum of time derivative of potential at the period of the QRS complex and by minimum of the T wave, respectively. It has been established that at the ventricle electrostimulation, alongside with deceleration and a change of sequence of the myocardium activation, there occurs redistribution of local repolarization durations: in areas of late activation the repolarization being longer than in zones of early activation (p < 0.05). At stimulation, the apicobasal gradient of repolarization is predominantly changed due to electrophysiological processes in the apical areas. In all studied species. at ectopical excitation of the heart ventricle the sequence of its repolarization repeats the depolarization sequence due to delay of activation (in fish) and redistribution of repolarization durations (in amphibians).

[Changes of repolarization properties of the right ventricle in hypertensive left ventricular hypertrophy].

Repolarization properties of left ventricular (LV) myocardium change during its hypertrophy of various genesis. Aim of this work was to study repolarization of epicardial surface of the right ventricle (RV) in experimental model of LV hypertrophy caused by renovascular hypertension in rats. We registered 32 unipolar electrograms on the surface of cardiac ventricles and calculated duration of activation recovery intervals for assessment of repolarization. In hypertensive rats relative LV mass was 26% greater than in control rats, while relative mass of RV was similar in both groups. Length of activation recovery intervals in hypertension was 1.7 times greater than in control group on both LV and RV surfaces. Dispersion of activation recovery intervals did not differ significantly between groups. Thus in LV hypertrophy in rats caused by renovascular hypertension electrical remodeling of myocardium occurs not only in left but also in right ventricle.

Changed duration of ventricle repolarization in dog heart under conditions of increased preload.

The duration of repolarization of subendocardial, intramural, and epicardial layers of dog ventricles was studied under conditions of volume overload of the heart in situ. Increased preload was modeled by rapid intravenous infusion of saline and rheopolygluquine. The activation-recovery interval was measured by flexible intramural electrodes inserted into the right and left ventricles. The level of preload was evaluated by the increase in left-ventricular end-diastolic pressure. The increase in preload from 11+/-6 to 26+/-10 mm Hg led to a significant (p<0.05) prolongation of the activation-recovery interval in the subepicardial layers of apex, all layers of the lateral wall, and subepicardial and intramural layers of the base of the left ventricle and in subendocardial layers of the apex and base of the right ventricle. Further elevation of the end-diastolic pressure to 34+/-11 mm Hg led to shortening of the activation-recovery interval (p<0.05) in the subepicardial layers of the apex and lateral wall of the left ventricle and in the subepicardial layers of right-ventricular base and left-ventricular lateral wall. Hence, different areas of the myocardium differently react to volume overload of the heart. Changes in repolarization length in response to preload increase are biphasic.

[Repolarization pattern of the ventricular myocardium in pikes].

The study aimed at investigation into the repolarization pattern in the myocardium of fish. Activation times, activation-recovery intervals and repolarization times were determined in the intramural layers of the heart ventricle in eight pikes with multiple plunge electrodes. In the heart ventricle of the pike, the earliest end of repolarization was found in the subendocardium of the base and the subepicardium of the apex, the areas corresponding to the earliest and latest depolarization, respectively. The latest repolarization was observation on the anterior epicardial surface of the base. Endocardialto-epicardial repolarization sequence at the base corresponded to the activation sequence in this area with the transmural gradient of the end of repolarization times being 54 +/- 23 ms (p < 0.001). The transmural difference in activation-recovery interval durations and end of repolarization times decreased as one moved from the base to apex with the maximal apex-to-base end of repolarization gradient being 133 +/- 98 ms (p < 0.10).

[Effect of ectopic excitation on pump function of the hen and dog right heart ventricle].

The pump function of the right heart ventricle has been studied in anesthetized dogs and hens at sinus rhythm, supraventricular rhythm, and subepicardial ectopic excitation of base and apex of the right and left ventricles. Dynamics of the ventricle intracavital pressure was recorded by transmural catheterization. The pump function of the right ventricle in hen (as compared with sinus rhythm) retained to the greater degree at stimulation of the left ventricle apex and deteriorated significantly at stimulation of the right ventricle, whereas in dog (as compared with supraventricular rhythm) it retained to the greater degree at stimulation of the left ventricle base and deteriorated at stimulation of the right ventricle apex. Changes of the pump function of the right heart ventricle at ectopic ventricle stimulation are similar in birds and mammals. Differences in changes of dog and hen pump functions under effect of location of the ectopic excitation seem to be due to morphofunctional peculiarities of heart ventricles.

Effects of ectopic pacing on repolarization of the chicken left ventricle.

Effects of ectopic pacing on left ventricular repolarization were studied in six anesthetized open-chest chickens. In each animal, unipolar electrograms were acquired from as many as 98 sites with 14 plunge needles (seven transmural locations between epicardium and endocardium in each needle). Activation-recovery intervals (ARIs), corrected to the cycle length, were used for estimating repolarization. At baseline, the nonuniform ARI distribution in the left ventricle resulted in the apicobasal differences being greater than the transmural gradient. Nonuniform ARI prolongation caused by ectopic pacing resulted in decreasing the transmural repolarization gradient and increasing the differences in the apex-to-base direction. The basal, but not apical transmural differences contributed to the total left ventricular transmural gradient. The total left ventricular apicobasal gradient was contributed by the apicobasal differences in mid-myocardial and subendocardial layers more than in subepicardial ones. Thus, in in situ chicken hearts, the transmural and apicobasal ARI gradients exist within the left ventricle with the shortest ARIs in the basal subepicardium and the longest ARIs in the subendocardium of the apical and middle parts of the left ventricle. Apicobasal compared to transmural heterogeneity of local repolarization properties contributes more to the total left ventricular repolarization gradient.

[Cardiac electric field at the period of depolarization and repolarization of the frog heart ventricle].

Multichannel mapping of electrical field on heart ventricle epicardium and the body surface in frogs Rana esculenta and Rana temporaria was performed at periods of the ventricular myocardium depolarization and repolarization. The zone of the epicardium early depolarization is located on epicardium of the ventricle base posterior wall, while the late depolarization zone--on its apex and on the base anterior wall. The total vector of sequence of the ventricle epicardium depolarization is directed from the base to the apex. The zone of the early repolarization is located in the apical area, while that of the late one--in the area of the base. On the frog body surface the cardioelectric field with the cranial zone of negative and the caudal zone of positive potentials is formed before the appearance of the QRS complex on ECG. At the period of the heart ventricle repolarization the zone of the cardioelectric field negative potentials is located in the cranial, while that of the positive ones--in the body surface caudal parts. The cardioelectric field on the frog body surface at the periods of depolarization and repolarization of the ventricle myocardium reflects adequately the projection of sequence of involvement with excitation and of distribution of potentials on epicardium.

[Effect of ectopic excitation on the ventricular pump function in chicken].

The pump function of the heart ventricles was studied in chest-open anaesthetized adult female chickens under sinus rhythm and ectopic excitation of different localization. The intraventricular pressure in the right and left heart ventricles was measured by insertion of catheters through the ventricular free walls. Maximum systolic pressure, end-diastolic pressure, contractility (dP/dtmax) and relaxation (dP/dtmin) of both heart ventricles, and duration of the asynchronous contraction time of the left ventricle were analyzed. It was revealed that reduction of the pump function of the left ventricle tends to be greater under right ventricular ectopic excitation compared with left ventricular one. In comparison with the sinus rhythm, the pump function of the right ventricle was preserved to a greater extent under stimulation of the left ventricular apex and was significantly impaired under right ventricular ectopic excitation. Relaxation of both heart ventricles was more susceptible to ventricular ectopic excitation than contractility, and was more vulnerable in the right ventricle than in the left one. The direction of changes of the pump function of the heart ventricles in chickens under ventricular ectopic excitation was similar to changes of the pump function of mammalian hearts.

[Repolarization of canine ventricular myocardium under the supraventricular rhythm].

The ventricular myocardium is characterized by heterogeneity of activation-recovery interval durations. The transmural ARI gradients are present in the right ventricular apex (ARIs monotonically decreased as one moved from the endocardium to the epicardium), and in the left ventricular base (repolarization in the subepicardial layers was significantly shorter than that in the midmyo cardial layers whereas subendocardial ARIs did not differ from the others). The repolarization pattern of these myocardial regions is governed by the distribution of ARIs. In the apical left ventricular and basal right ventricular areas, no significant transmural differences in the repolarization durations were found. The repolarization pattern of these myocardial regions is governed by the activation sequence. In the right ventricle, ARIs were significantly longer at the base and shorter at the apex. In contrast, in the left ventricle, the apical ARIs were prolonged whereas the basal ARIs were abbreviated. The apex-to-base sequence of myocardial repolarization seems to depend on apex-to-base gradient of activation-recovery intervals durations.

[Ventricular pump function under ectopic excitation of the frog heart].

The ventricular pump function under ectopic excitation of the heart was studied in decapitated and pithed adult frogs Rana temporaria (n = 21) at 18-19 degrees C. The intraventricular pressure was recorded with a catheter via ventricular wall. During pacing of the ventricular base and apex, the systolic pressure decreased (6.1 +/- 4.5 mm Hg and 8.9 +/- 5.0 mm Hg, respectively) as compared to the supraventricular rhythm (8.9 +/- 5.0 mm Hg, p < 0.05). The end-diastolic pressure decreased insignificantly both under basal and apical pacing. The systolic rate of pressure rise during dP/dtmax decreased under ventricular pacing, especially during pacing of the ventricular apex, as compared to the supraventricular rhythm (14.4 +/- 6/9 mm Hg/s and 22.1 +/- 11.2 mm Hg/s, respectively, p < 0.003). The isovolumetric relaxation (dP/dtmin) slowed during apical pacing as compared to the supraventricular rhythm (-25.1 +/- 13.6 and -35.6 +/- 18.3 mm Hg/s, respectively, p < 0.03). Ectopic excitation of the ventricular base and apex resulted in increase of the QRS duration (93 +/- 33 ms and 81 +/- 30 ms, respectively) as compared to the supraventricular rhythm (63 +/- 13 ms, p < 0.05). Thus, pacing of different ventricular areas ventricular myocardium with the ventricular pump function being reduced more obviously during the apical pacing compared to the pacing of ventricular base.

[Structure of the cardiac systole in mammals and birds].

The comparative analysis of the contractile function of the heart left ventricle in four species of homoeothermic tetrapods (chicken, quail, rat, sheep) who differ in their spatio-temporal pattern of ventricular excitation, heart rate, and heart weight was performed. The analysis of cardiac cycle structure was performed on the basis of synchronous recording of ECG, phonocardiogram, and apex cardiogram. Indices of myocardial contractility of the left ventricle calculated on the basis of the analysis of the cardiac dynamics indicate disadvantageous contractile function of the left ventricle in rodents and non-flying birds in comparison with sheep. The functioning of the left ventricle in male rats is more strained than in female rats. One fundamental factor determining a more strained functioning of the left ventricle in birds in comparison with mammals is the heart rate. The relative weight and activation pattern of the left ventricular myocardium govern the contractile function of the left ventricle to a lesser extent.

Ventricular repolarization pattern under heart cooling in the rabbit.

AIM: Prolongation of ventricular repolarization is characteristic of myocardial cooling. In the present study, we investigated whether this prolongation is uniform or not throughout ventricular epicardium and how these hypothermia-induced changes express in the body surface potential distribution. METHODS: Epicardial and body surface potential mapping from 64 unipolar leads was carried out in 18 anaesthetized adult rabbits. Mild hypothermia documented by lowering the mediastinal and rectal temperature from 38 to 32 degrees C was elicited by perfusion of the mediastinum with cooled saline. Activation times, repolarization times and activation-recovery intervals were determined in each epicardial lead. RESULTS: Baseline activation-recovery intervals distributed non-uniformly on the ventricular epicardium, increasing progressively from the apex to the base and from the left ventricular (LV) sites to the right ventricular (RV) sites (P < 0.05), governing the repolarization sequence of ventricular epicardium. Heart cooling from 38 to 32 degrees C produced the heterogeneous prolongation of activation-recovery intervals which was more pronounced at the apex than at the base, and in the LV areas compared to the RV areas (P < 0.05). These nonuniform changes in local repolarization durations resulted in the development of base-to-apex repolarization sequence and inversion of the body surface potential distribution during the T wave. CONCLUSION: Thus, under cooling the rabbit heart from 38 to 32 degrees C, the nonuniform prolongation of local repolarization durations resulted in the reversal of ventricular epicardial repolarization sequence which, in turn, was responsible for the inversion in the body surface potential distribution during the T wave.